Abstract:Objective To establish a cell model of primary neuronal hypoxic-ischemic brain injury and explore the effects of circular RNA-ZNF292 (cZNF292) on neuronal oxidative stress and apoptosis after hypoxic-ischemic brain injury.Methods The primary neurons were cultured in fetal rats on the 18^th day of pregnancy. The cells were treated with 4, 10 mmol/L Na₂S₂O₄ and glucose-free medium for 1, 2, 3 and 4 h, and reoxygenated for 0, 5, 15 and 30 h to establish the oxygen and glucose deprivation/reoxygenation cell model. The morphological changes of primary neurons were observed by immunofluorescence staining of cytoskeletal proteins and β3-tubulin, the effects of different concentrations of Na₂S₂O₄ on the survival rate of primary neurons were observed by fluorescein isothiocyanate (FITC)-phalloidin staining. The expression levels of reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD) and lactate dehydrogenase (LDH) in the culture supernatant were detected by enzyme-linked immunosorbent assay (ELISA). The expression levels of caspase 3 and cyclin G1 (CCNG1) were detected by Western blotting.Results The hypoxic-ischemic brain injury cell model and cZNF292-knockdown model were successfully established and the highest inhibition rate was observed in 10 mmol/L Na₂S₂O₄ and reoxygenation 4 h after deoxygenation. The expression level of cZNF292 was the highest in cells after reoxygenation culture for 15 h. Therefore, hypoxia culture for 4 h, reoxygenation culture for 15 h and 10 mmol/L Na₂S₂O₄ were selected as the best experimental conditions. Oxygen and glucose deprivation increased the levels of ROS and MDA, and decreased the levels of SOD and LDH in cell culture medium (all P < 0.05); after knockdown of cZNF292, the levels of ROS and MDA were decreased, and the levels of SOD and LDH were increased (all P < 0.05). Knockdown of cZNF292 decreased the expression of caspase 3 and CCNG1 (both P < 0.05).Conclusion Cerebral ischemia can increase expression of cZNF292 in primary neurons, while knockdown of cZNF292 can alleviate the oxidative damage, inhibit cell apoptosis and proliferation of primary neurons in the environment of ischemia and hypoxia.

Abstract:Objective To investigate the molecular mechanism of tumor protein 63 with truncated transactivation domain (ΔNp63) in regulating the proliferation and migration of esophageal squamous cell carcinoma (ESCC) cells.Methods With ECA109 cells as a model, ΔNp63 was overexpressed in cells by transgene mediated with lentivirus. The expression level of 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) was detected by quantitative polymerase chain reaction and Western blotting, and the binding of ΔNp63 and the 5'-untranslated region (5'-UTR) of HMGCR was detected by chromatin immunoprecipitation (ChIP) and luciferase activity reporter assay. ΔNp63 was overexpressed in cells and the expression of HMGCR was inhibited by RNA interference. Cell proliferation was detected by cell counting kit 8 (CCK-8), apoptosis was detected by flow cytometry, and cell migration was detected by Transwell chamber culture.Results The mRNA and protein expression levels of HMGCR were increased after overexpressing ΔNp63 in ECA109 cells (both P < 0.01). The results of the ChIP and luciferase activity reporter assay showed that the ΔNp63 recognition site was located in the -728 to -747 bp region of the HMGCR promoter. The cell proliferation ability of the group overexpressing ΔNp63 and inhibiting HMGCR expression was significantly lower than that of the group overexpressing ΔNp63 alone at 24, 48 and 72 h (all P < 0.05); the level of apoptosis was (26.9±1.9)%, which was significantly higher than that of the group overexpressing ΔNP63 alone ([16.6±1.5]%, P < 0.01); meanwhile, the cell migration rate was significantly lower than that of the group overexpressing ΔNp63 alone ([33.4±3.1]% vs[52.2±2.6]%, P < 0.01).Conclusion ΔNp63 can promote the proliferation and migration of ESCC cells by up-regulating the transcriptional expression of HMGCR.

Abstract:Objective To investigate the chemosensitization effects of genistein (Gen) combined with 5-fluorouracil (5-FU) on hepatocellular carcinoma in vitro and in vivo.Methods In the in vitro experiments, human hepatocellular carcinoma cell lines (Bel-7404, SMMC-7721 and HepG2) were used in negative control (NC) group, Gen group (10 μmol/L), 5-FU group (2 μmol/L) as well as Gen+5-FU group according to the intervention methods. The effects of Gen combined with 5-FU on the proliferation and apoptosis of hepatocellular carcinoma cells were analyzed by cell counting kit 8 (CCK-8) method and flow cytometry. Bel-7404 cell line-derived xenograft (CDX) and Liver-0117 patient-derived xenograft (PDX) mouse models were constructed in vivo. Then the tumor-bearing mouse models were divided into 4 groups:NC group, Gen group, 5-FU group and Gen+5-FU group. The effects of different treatment methods on tumor growth were observed.Results The proliferation rates of Bel-7404, SMMC-7721 and HepG2 cells in the Gen+5-FU group were significantly lower than those in the Gen group and 5-FU group (all P < 0.01) after 24, 48 and 72 h of treatment; the average apoptosis rates of these cells were significantly higher in the Gen+5-FU group than in the NC group, Gen group and 5-FU group after 72 h of culture (all P < 0.01). The relative tumor volumes (RTVs) of the Bel-7404 CDX tumor-bearing mice in the NC group, Gen (15 mg/kg) group, 5-FU (30 mg/kg) group and Gen (15 mg/kg)+5-FU (20 mg/kg) group 28 d after administration were 15.35±2.92, 17.51±3.11, 12.93±4.88 and 13.67±3.54, respectively, showing no significant difference (F=1.822, P > 0.05); after increasing the dose of Gen to 40 mg/kg for 21 d, the RTV of the Gen (40 mg/kg) group was significantly lower than that of the NC group (9.73±5.85 vs 17.54±5.06, P < 0.05). The RTV of the Liver-0117 PDX tumor-bearing mice in the Gen (15 mg/kg)+5-FU (20 mg/kg) group 18 d after administration was significantly lower than that in the 5-FU (30 mg/kg) group (12.64±0.92 vs 18.76±0.68, P < 0.05), and the ratio of RTV between treatment group and control group was 0.576.Conclusion Gen combined with 5-FU shows good chemosensitization effects in vitro, which are varied on different models of tumor-bearing mice.

Abstract:Objective To prepare doxorubicin (Dox)-loaded hollow mesoporous manganese dioxide (H-MnO₂) nanoparticles encapsulated with pH-sensitive fusion membrane (MP) (MP@H-MnO₂-Dox nanoparticles), and investigate its characteristics in vitro.Methods With solid silica as template, H-MnO₂ was synthesized by alkali etching. Dox-loaded H-MnO₂ (H-MnO₂-Dox) was prepared and was coated with MP to construct MP@H-MnO₂-Dox nanoparticles. The particle size, drug loading and proportion of MP coating carriers were investigated, the oxygen production capacity was evaluated by tris(4, 7-diphenyl-1, 10-phenanthroline)ruthenium(Ⅱ) dichloride (RDPP) probe, the drug release in vitro was investigated by dialysis, and the celluar uptake and distribution were investigated by confocal laser scanning microscopy.Results H-MnO₂ was successfully prepared. The drug-loading rate and encapsulation efficiency were (79.0±8.7)% and (75.1±7.5)%, respectively. H-MnO₂ could be coated well with the mass ratio 1:1 of MP to H-MnO₂. The particle size of MP@H-MnO₂-Dox nanoparticles was (178.0±9.5) nm. The results of RDPP showed that H-MnO₂ possessed superior oxygen production capacity. In vitro drug release results showed that MP could delay Dox release, and the Dox cumulative release amount of MP@H-MnO₂-Dox (pH=6.5) was lower than that of H-MnO₂-DOX (pH=6.5) ([42.0±5.1]% vs[60.0±3.7]%). The results of uptake experiments showed that MP@H-MnO₂-Dox nanoparticles had strong cellular uptake at pH=6.5.Conclusion MP@H-MnO₂-Dox nanoparticle is successfully constructed. This biomimetic nanosystem is expected to be a multifunctional drug delivery vehicle for alleviating hypoxia and targeting breast cancer.

Abstract:Objective To investigate the efficacy, prognostic factors and adverse reactions of intravesical instillation with Bacillus Calmette-Guérin (BCG) in patients with non-muscle-invasive bladder cancer (NMIBC). Methods The clinical data of 147 patients with moderate-to-high risk NMIBC who received BCG intravesical instillation after transurethral resection of bladder tumor (TURBT) in the Department of Urology of our hospital from Apr. 2014 to Apr. 2021 were retrospectively analyzed. Cumulative recurrence rate, cumulative progression rate, 1-year relapsefree survival rate, mean relapse-free time and mean progression-free survival time were used to evaluate the efficacy of BCG intravesical instillation, univariate and multivariate Cox regression analyses were used to explore the relapserelated risk factors, and Common Terminology Criteria for Adverse Events (CTCAE) Vesion 5.0 was used to evaluate adverse reactions. Results There were a total of 147 patients including 128 males (87.1%) and 19 females (12.9%), with a median follow-up time of 25 (4-85) months and an age of 39-98 (66.5±10.6) years. The 1-year relapsefree survival rate was 81.9% (104/127), the cumulative recurrence rate was 21.8% (32/147), and the mean relapsefree survival time was 49.49 months; the cumulative progression rate was 9.5% (14/147), and the mean progressionfree survival time was 56.81 months. Univariate analysis showed that relapse history (P=0.004) and pathological stage (P=0.069) of bladder cancer were correlated with tumor relapse. Multivariate Cox regression analysis showed that the relapse history of bladder cancer (hazard ratio[HR]=2.081, 95% confidence interval[CI]1.048-4.130, P=0.036) was an independent predictor of cancer relapse after BCG intravesical instillation. Adverse reactions occurred in 86.6% (110/127) patients during BCG intravesical instillation, including grade 1 adverse reactions in 38 cases (29.9%), grade 2 adverse reactions in 69 cases (54.3%), and grade 3 adverse reactions in 3 cases (2.4%), and there were no grade 4 or 5 adverse reactions. There were 9.5% (14/147) patients who discontinued treatment due to intolerance of adverse reactions. Conclusion Intravesical instillation with BCG after TURBT is effective in patients with moderate-to-high risk of NMIBC, and relapse history of bladder cancer is an independent predictor for tumor relapse. Some adverse reactions may occur in patients during BCG intravesical instillation, but most of them can be tolerated.

Abstract:Objective To investigate the effect of cervical Pavlov ratio on cervical degeneration and cervical-related clinical manifestations in young and middle-aged military population.Methods The demographic, imaging and clinical data of 18-40 years old military patients mainly complaining "neck pain" longer than 3 months were collected from Jan. 2021 to Aug. 2021. All samples were grouped by systematic cluster analysis according to X-ray measurement data. The bone degeneration, intervertebral disc degeneration and neck disability index (NDI) scores of the groups were compared and analyzed.Results A total of 129 cases (all males) were included. The samples were divided into 3 groups:high Pavlov ratio group (1.12-1.23[1.18±0.04], 21 cases), medium Pavlov ratio group (0.83-1.11[0.96±0.06], 84 cases) and low Pavlov ratio group (0.69-0.82[0.77±0.04], 24 cases). There were significant differences in vertebra diameter (VD), canal diameter (CD), lateral mass width (LM), spinolaminar line-to-lateral mass distance (SL), Pavlov ratio, LM/SL ratio, bone degeneration, Pfirrmann grade and Kang grade among the 3 groups (all P < 0.05). High Pavlov ratio group mainly manifested low VD, high CD and SL, with most serious bone degeneration; medium Pavlov ratio group showed high LM and LM/SL ratio, with the lightest bone degeneration; and low Pavlov ratio group presented high VD, low CD and SL, with the highest Pfirrmann grade and Kang grade. No significant difference was observed in age, lordosis or NDI score among the 3 groups (all P>0.05). There was no significant correlation between overall Pavlov ratio and NDI score (r=-0.035, P=0.691). A positive correlation between Pavlov ratio and NDI score in the high Pavlov ratio group (r=0.541, P=0.011) and a negative correlation in the low Pavlov ratio group (r=-0.642, P=0.001) were demonstrated, without significant correlation in the medium Pavlov ratio group (r=-0.057, P=0.604).Conclusion Compared with patients of medium Pavlov ratio, the patients of high or low ratio present unbalanced development of vertebra and vertebral arch and more obvious degeneration of bone and intervertebral disc, and the severity of clinical symptoms increases with the escalation of the deviation trend of the Pavlov ratio. Pavlov ratio can be used as a high-risk anatomic factor for the neck pain and cervical spine degeneration, or as a reference selection index to measure the competency of specific posts in the army.

Abstract:Objective To analyze the facial feature indexes related to difficult visual laryngoscopic glottis exposure.Methods A total of 537 patients who underwent craniomaxillofacial surgery and tracheal intubation under general anesthesia were recruited from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from Aug. to Oct. 2020, with American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ. The age, gender, height, weight and body mass index (BMI) of patients were obtained before anesthesia, and the photographs of patients in frontal neutral position, mouth opening with tongue extending position and head-up position were collected to quantify labeled facial features. When anesthesiologists performed tracheal intubation with a unified visual laryngoscope, the Cormack-Lehane (C-L) grade was recorded by the statistician. Subjects were assigned to easy visual laryngoscopic glottis exposure group (C-L grade Ⅰ-Ⅱ) or difficult visual laryngoscopic glottis exposure group (C-L grade Ⅲ-Ⅳ) according to the C-L grade. Subjects in the difficult group were matched 1:1 with those in the easy group based on age (difference of no more than 2 years) and gender. The facial feature indexes of the 2 groups were analyzed with the real results of visual laryngoscopic glottis exposure by multivariate logistic regression analysis to summarize the positive indexes useful for assessment.Results Thirty-one pairs of subjects were successfully matched with an age ranged from 15 to 75 years. The age of the difficult group and easy group was (49.29±17.47) and (49.23±17.47) years, respectively, and there was no significant difference in BMI between the 2 groups ([22.18±3.55] kg/m² vs[23.33±3.06] kg/m², P>0.05). For the facial features, the proportion of the distance from brow to nasal tip to the distance from the apex of the coronal surface of the frontal scale to the chin and the restriction of tongue extension were significantly different between the 2 groups (both P < 0.01). Multivariate logistic regression analysis found that the proportion of the distance from brow to nasal tip to the distance from the apex of the coronal surface of the frontal scale to the chin was significantly related to difficult laryngoscopic exposure (odds ratio[OR]=1.25, 95% confidence interval[CI] 1.02-1.53, P < 0.05).Conclusion Patients who have difficulty in glottic exposure with visual laryngoscope have some facial features that are different from easy exposure patients. They are more likely to have facial features with an increased proportion of brow to tip distance.

Abstract:Objective To analyze the characteristics of intestinal flora in children with chalazion, and explore the relationship between the composition of intestinal flora and chalazion.Methods Fecal samples were collected from 21 children with chalazion and 26 healthy children. DNA was extracted from the fecal samples, and the 16S rRNA sequences were detected by the second generation sequencing technology. The results were used to compare the composition of the microbiome between children with chalazion and healthy controls.Results There was no significant difference in intestinal flora diversity or relative abundance between or in the 2 groups according to the alpha and beta diversity. Eleven differential species were screened out by the linear discriminant analysis effect size (LEfSe) analysis. ANOSIM analysis, t test and metastats analysis were used to compare the intestinal flora of the healthy control group and chalazion group. The results of t test showed 7 differential species, and metastats analysis results showed 40 differential species. Gut_metagenome and human_gut_metagenome were common differential species at the species level. Finally, corrplot analysis showed that gut_metagenome was strongly correlated with the number, ulceration and postoperative recurrence of chalazion in children (r=0.70, 0.76, 0.85, all P < 0.01).Conclusion There is no significant difference in intestinal diversity or relative abundance between children with chalazion and healthy children, but there are significant differences in some bacterial species. Gut_metagenome may be a microbiological indicator which is independent of clinicopathologic factors, but is associated with chalazion disease.

Abstract:Objective To explore the role of mental resilience in mediating personality traits and state-anxiety.Methods With cluster sampling, 591 newly recruited sergeants from a training base were investigated using the Connor-Davidson resilience scale (CD-RISC), trait-state-anxiety scale and simplified personality factor questionnaire. The relationships between variables were analyzed by correlation analysis, hierarchical regression analysis and structural equation model.Results A total of 579 valid questionnaires were collected, with an effective rate of 97.97%. The correlation analysis revealed that state-anxiety was negatively associated with mental resilience and personality traits of stability, dominance, rule conscious, social boldness and perfection (all P < 0.01), and positively correlated with personality traits of apprehension, self-reliance and tension (all P < 0.01); mental resilience was positively correlated with personality traits of stability, dominance, rule conscious social boldness and perfection (all P < 0.01) and was negatively correlated with personality traits of apprehension and tension (both P < 0.01). Hierarchical regression analysis showed that the personality traits of stability, apprehension, tension and mental resilience could independently predict state-anxiety. The analyses of 2 structural equation models indicated that when the 3 independent variables (stability, apprehension and tension) were included, except tension (P=0.117), the mediating effects of mental resilience between the other 2 independent variables (stability and apprehension) and state-anxiety were significant (both P < 0.001); while 2 independent variables (stability and apprehension) were included, the mediating effects of mental resilience between both of them and state-anxiety were significant (both P < 0.001), and there was no significant difference between the effect size of stability and apprehension (P=0.706).Conclusion Mental resilience can partially mediates the relationship between personality traits (stability and apprehension) and state-anxiety. Improving the mental resilience and personality trait of stability and reducing the personality trait of apprehension can effectively reduce the level of state-anxiety of newly recruited sergeants.

Abstract:Degenerative scoliosis and osteoporosis mainly occurr in the elderly, and both can lead to serious spinal lesions. Early studies have found that osteoporosis may participate in the pathogenesis of degenerative scoliosis involving vertebral body asymmetric degeneration and decreased trunk muscle strength; however, a few studies have shown that there is no obvious relationship between them. This article reviews how osteoporosis participates in the pathogenesis of degenerative scoliosis, aiming to further clarify whether osteoporosis has an impact on the spine of patients, so as to provide evidence for the prevention and treatment of degenerative scoliosis.

Abstract:Cervical hyperextension injury refers to the injury of the cervical vertebra, its supporting structure and spinal cord caused by excessive extension of the cervical vertebra under the violent action of craniofacial horizontal force, and it is a common type of cervical vertebra injury. Cervical hyperextension injury is more common in the elderly with spinal stenosis, and there are few serious clinical fracture and dislocation, mainly manifested as incomplete spinal cord injury such as central cord syndrome. This article reviews the research progress of injury mechanism and surgical treatment of cervical hyperextension injury.

Abstract:Objective To study the current status and related factors of life satisfaction and well-being of soldiers during long-distance sailing.Methods Totally 476 soldiers in Chinese navy escort fleets in Aden Gulf were selected by random cluster sampling method. After 2-month long-distance sailing, the status of insomnia, depression, anxiety, life satisfaction and well-being was evaluated by insomnia severity index (ISI) scale, patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7), satisfaction with life scale (SWLS) and mental health continuum-short form (MHC-SF), respectively.Results A total of 469 valid questionnaires were collected, with an effective rate of 98.53%. During the escort, 44.35% (208/469), 37.10% (174/469) and 19.62% (92/469) of the soldiers suffered from insomnia, depression and anxiety to different extents, respectively. The overall life satisfaction of the soldiers was lower than the national norm (21.11±6.01 vs 23.60±6.10), while the well-being was better than the national norm (3.64±0.91 vs 3.24±1.00) (both P < 0.01). The soldiers with service age > 6 years had significantly aggravated insomnia and anxiety symptoms and lower emotional well-being. The emotional well-being was also markedly decreased in married soldiers with children. The life satisfaction was much lower in soldiers who participated in escort for the first time. Night duties also aggravated insomnia and anxiety symptoms, and lowered the life satisfaction and well-being of soldiers. Night duties over 3 h, night duties with the interval of 10~< 14 h or suffering from oral ulcer could significantly aggravate insomnia, depression and anxiety symptoms, and lower the life satisfaction and well-being. Life satisfaction and well-being were negatively correlated with insomnia, depression and anxiety (all P < 0.01). Insomnia, depression and anxiety could significantly lower the life satisfaction and well-being (all P < 0.01).Conclusion Soldiers during long-time sailing may suffer from insomnia, depression and anxiety to different extents. They have low life satisfaction but strong well-being. Insomnia and emotion disorders can lower their life satisfaction and well-being.

Abstract:Objective To evaluate the sleep quality, suicidal ideation and mental resilience of military personnel, and explore the role of mental resilience in moderating sleep quality and suicidal ideation.Methods Participants were recruited from military personnel by cluster sampling in May 2020. Pittsburgh sleep quality index (PSQI) scale, self-rating idea of suicide scale (SIOSS) and Connor-Davidson resilience scale (CD-RISC) were used to evaluate their sleep quality, suicidal ideation and mental resilience, respectively.Results A total of 13 831 questionnaires were collected, of which 10 367 were effective, with an effective rate of 74.95%. The total score of PSQI scale was 5.04±3.60, and the detection rate of poor sleep quality was 21.13% (2 191/10 367); the total score of SIOSS was 2.84±3.33, and the detection rate of suicidal ideation was 3.30% (342/10 367); and the total score of CD-RISC was 70.54±15.32. There were significant differences in sleep quality, suicidal ideation and mental resilience among officers and soldiers with different genders and education backgrounds (all P < 0.05). After controlling for sociodemographics, sleep quality (β=0.46, P < 0.01), mental resilience (β=-0.31, P < 0.01) and their interaction (β=-0.20, P < 0.01) had significant predictive effects on suicidal ideation.Conclusion Mental resilience plays a negative moderating effect between sleep quality and suicidal ideation. Tailored mental resilience training should be developed for officers and soldiers to improve their mental resilience, so as to attenuate the adverse effects of risk factors such as poor sleep quality.

Abstract:Objective To retrospectively analyze the feasibility and safety of surgical resection for patients with retroperitoneal ganglioneuroma involving abdominal major vessels.Methods A total of 23 patients with retroperitoneal ganglioneuroma involving abdominal major vessels (such as abdominal aorta, coeliac trunk and superior mesenteric artery) admitted to Changhai Hospital, Naval Medical University (Second Military Medical University) from Jan. 2020 to Sep. 2021 were enrolled. All patients underwent surgical resection and were confirmed by postoperative pathology. The clinical data including gender, age, tumor diameter, operation time, intraoperative blood loss, drainage duration, complications and follow-up outcomes were collected.Results Among the 23 patients, there were 9 males and 14 females, aged 36 (17-65) years. The surgery was successful in all cases, the operation time was 60 (45-170) min, the intraoperative blood loss was 100 (100-2 300) mL, the tumor diameter was 3 (3-11) cm, the postoperative hospital stay was 4 (3-14) d, and the drainage duration was 4 (3-20) d. Lymphaitc leakage occurred in 5 cases, and no serious postoperative complications (such as vascular rupture or occlusion) occurred. As of Nov. 2021, there was no tumor recurrence in the patients.Conclusion Though surgical resection for patients with retroperitoneal ganglioneuroma involving abdominal major vessels is difficult, it still could be a safe and reliable treatment when the surgeons have extensive vascular surgery experience.

Abstract:Objective To investigate the predictive value of serum nesfatin 1 (NSF-1), obestatin (OB) and glucagon-like peptide 1 (GLP-1) levels for the adverse pregnancy outcomes of patients with gestational diabetes mellitus (GDM).Methods From Jan. 2019 to Dec. 2020, 122 GDM women (GDM group) and 75 healthy pregnant women (normal pregnancy group) who visited our hospital were enrolled. The venous blood was collected to compare the levels of serum NSF-1, OB and GLP-1 in the 2 groups, and the relationship between the levels of serum NSF-1, OB and GLP-1 and the degree of blood glucose control in GDM patients was analyzed. Univariate and multivariate binary logistic regression analyses were performed in GDM patients with poor pregnancy outcomes, and ROC curves were drawn to evaluate the diagnostic efficacy of serum NSF-1, OB and GLP-1 levels in predicting poor pregnancy outcomes of GDM patients.Results The serum NSF-1 level in the GDM group was significantly higher than that in the normal pregnancy group (P < 0.01), and increased with the increase of gestational week and the improvement of blood glucose control (both P < 0.01). The serum levels of OB and GLP-1 were significantly lower in the GDM group (P < 0.01), and decreased with the increase of gestational week and the improvement of blood glucose control (all P < 0.01). The serum levels of glycosylated hemoglobin (HbA1c) and NSF-1 in the poor pregnancy outcome group were significantly higher than those in the good pregnancy outcome group (both P < 0.01), while the serum levels of OB and GLP-1 were significantly lower in the good pregnancy outcome group (both P < 0.01). Multivariate binary logistic regression analysis showed that the levels of serum NSF-1, OB and GLP-1 were independent prognostic factors of poor pregnancy outcomes (all P < 0.01). The serum levels of NSF-1, OB and GLP-1 had a higher diagnostic efficiency in predicting poor pregnancy outcomes of GDM patients. The sensitivity of the combined detection was 97.4%, specificity was 83.3% and AUC was 0.966, which was significantly higher than those of the single index (NSF-1[Z=4.078, P < 0.01], OB[Z=4.059, P < 0.05] and GLP-1[Z=2.918, P < 0.01]).Conclusion The levels of serum NSF-1, OB and GLP-1 in GDM patients are risk factors of poor pregnancy outcomes, and have high diagnostic efficiency in predicting poor pregnancy outcomes.

Abstract:Objective To evaluate the safety of gadoterate meglumine injection in routine contrast-enhanced magnetic resonance imaging (MRI) of newborns and infants under 2 years old.Methods It was a prospective, multicenter and non-intervention observational study. A total of 360 newborns and infants under 2 years old who were to receive contrast-enhanced MRI after gadoterate meglumine injection were enrolled from 7 centers in China. Gadoterate meglumine was injected intravenously at the dose of 0.2 mL/kg, and then washed with the same dose of physiological saline. Each child was administered with gadoterate meglumine only once during each contrast-enhance MRI, and the interval between 2 administrations was more than 7 d. The incidence of acute adverse events/reactions was analyzed after gadoterate meglumine injection in newborns and infants under 2 years old.Results The age of the 360 children ranged from 2 d to 24 months, with an average age of (8.20±7.19) months and a median age of 6.00 months. They all received 1 injection of gadoterate meglumine, with an average injection dose of (1.59±0.71) mL. Only 1 child (0.28%, 1/360) had an acute adverse event, presenting as mild vomiting, which was considered to be unrelated to gadoterate meglumine. No measures were taken, and the patient was relieved spontaneously. No treatment-related serious acute adverse events/reactions occurred.Conclusion It is safe for newborns and infants under 2 years old to receive contrast agent gadoterate meglumine injection before contrast-enhanced MRI, and it can be popularized in clinic.

Abstract:Objective To report a case of missed diagnosis of small renal carcinoma by ultrasonography, and to explore the diagnosis methods and the causes of misdiagnosis and missed diagnosis of small renal carcinoma by ultrasonography through literature review.Methods The diagnosis and treatment process of 1 case of small renal carcinoma missed by ultrasonography was reported, the relevant domestic literatures from Jan. 1, 1995 to Aug. 30, 2020 were reviewed, and the ultrasound diagnosis methods and the causes of missed diagnosis and misdiagnosis of small renal carcinoma were summarized.Results The right renal space occupying of the patient was missed in the first ultrasound examination, and only the left renal space occupying was detected. Without any change of the examination equipment, only with improved examination conditions, the ultrasound reexamination still failed to detect the right renal space occupying. After replacing the ultrasound equipment with higher imaging quality ones for 2 consecutive times and with improved examination conditions, the case was diagnosed as bilateral renal space occupying, with a high probability of malignancy. Postoperative pathology confirmed renal clear cell carcinoma in both renal masses. A total of 37 literatures related to ultrasound diagnosis of small renal carcinoma were retrieved, including 1 611 cases. The ultrasound echo types of small renal carcinoma were mainly hyperechoic (39.4%[329/836]) and hypoechoic (39.0%[326/836]). The dendritic blood flow signal in the parenchyma (44.7%[220/492]) was the most visible color Doppler flow signal in small renal carcinoma. Small renal carcinoma had the characteristic of "fast in and fast out" by contrast-enhanced ultrasound, and there were significant differences in contrast-enhanced ultrasound of different pathological types of small renal carcinoma (χ_c²=37.58, P=0.01). The sensitivity of conventional ultrasound in the diagnosis of small renal carcinoma was not significantly different from that of contrast-enhanced ultrasound, plain CT+enhanced CT or plain MRI+enhanced MRI (χ²=0.30, P=0.96). The misdiagnosis rate and missed diagnosis rate of small renal carcinoma by conventional ultrasound were 15.3% (139/908) and 1.8% (17/919), respectively. Renal hamartoma was the most common misdiagnosis disease (47.3%[52/110]). The factors of missed diagnosis mainly included the image quality of ultrasound equipment, the relative position of small renal carcinoma, the factors of the operator and the patients' conditions.Conclusion The echo type, blood flow, filling of contrast agent and regression speed of small renal carcinoma show different characteristics. The quality of ultrasound equipment may affect the screening of small renal carcinoma. Ultrasound physicians who fully understand the performance of the equipment and fully understand the clinical, imaging and pathological characteristics of patients, are helpful to improve the diagnosis accuracy of small renal carcinoma.

Abstract:Objective To observe the protective effects of 2 kinds of protective stickers made from different materials on facial injury/discomfort caused by wearing protective appliances of military medical members in the medical team supporting Hubei, so as to provide reference for developing convenient and effective protective measures.Methods Totally 147 military medical members in the medical team supporting Hubei were surveyed by the self-designed questionnaire of facial injury/discomfort caused by wearing protective appliances. Cross-sectional survey of the facial injury/discomfort before and after using the protective gel stickers (Haishen stickers, developed by the Faculty of Pharmacy, Naval Medical University[Second Military Medical University]) or 3M hydrophilic dressing was conducted, and the protective effects of the 2 kinds of protective stickers on facial injury/discomfort were compared.Results A total of 78 medical members finished the questionnaires (62 cases with Haishen stickers and 16 cases with 3M hydrophilic dressings). The scores of facial injury/discomfort were significantly reduced in both groups after using the protective stickers (both P < 0.05); however, there was no significant difference between the 2 groups before or after using the protective stickers (both P > 0.05). The top 4 moderate-to-severe facial injury/discomfort were fogging of protective glasses/masks (85.9%, 67/78), skin indentation (80.8%, 63/78), pain at the contact sites (74.4%, 58/78) and sultry (71.8%, 56/78), and the overall proportion of moderate-to-severe injury/discomfort was 80.8% (63/78); after using the protective stickers, the top 4 moderate-to-severe facial injury/discomfort were fogging of glasses/masks (53.8%, 42/78), sultry (41.0%, 32/78), respiratory resistance (41.0%, 32/78) and skin indentation (38.5%, 30/78), with the overall proportion of moderate to severe injury/discomfort being 43.6% (34/78); and the top 4 improvement rates of facial injury/discomfort after using protective stickers were skin erosion (76.5%), skin redness (67.3%), pain at the contact sites (63.8%), and itching at the contact site (52.9%).Conclusion These 2 kinds of protective stickers made from different materials can improve the facial injury/discomfort caused by protective appliances, which is worth popularizing.

Abstract:Objective To investigate the influence of negative emotions on risk perception in frontline medical staff at the early stage of coronavirus disease 2019 (COVID-19) outbreak.Methods An online questionnaire survey was conducted on the dispatched medical staff of Wuhan Huoshenshan Hospital and the frontline anti-epidemic medical staff of Changhai Hospital of Naval Medical University (Second Military Medical University) from Feb. 3 to 5, 2020. The negative emotions were measured by the reduced version of negative affection scale composed of 7 negative emotions. The risk perception level was evaluated by the risk perception questionnaire of frontline anti-epidemic medical staff adapted from nursing staff risk perception questionnaire.Results A total of 220 valid questionnaires were collected, with an effective rate of 85.94%. The total score of negative emotions of frontline medical staff at the early stage of COVID-19 outbreak was 11.18±4.58, and the scores of 7 negative emotions from high to low were tension (1.92±0.90), upset (1.75±0.92), fear (1.61±0.84), impatience (1.58±0.84), sadness (1.51±0.83), trembling (1.50±00.83) and guilt (1.31±0.64). The scores of impatience, sadness, upset and guilt of non-nursing staff were significantly higher than those of nursing staff (all P < 0.05). The total score of risk perception of medical staff was 17.68±4.60, and the score of time risk dimension was the highest (3.20±1.20). The organizational risk score (3.39±1.01 vs 2.88±1.01) and time risk score (3.46±1.22 vs 3.09±1.18) of the non-nursing staff were significantly higher than those of the nursing staff (P < 0.01 or P < 0.05). There was a positive correlation between the total score of negative emotions and the total score of risk perception (r=0.499, P < 0.01). The score of each negative emotion classification had an indicating effect on different risk perception tendencies, and impatience had the most obvious indicating effect on time risk (β=0.227, P=0.033).Conclusion Medical staff with high negative emotions have high risk perception. The negative emotion management at the early stage of the epidemic can help frontline anti-epidemic medical staff to correctly understand the risk.

Abstract:

Abstract: